TOPIC IN GERIATRICS: Multi-Directional Functional Reach (MDFR)
The Multi-Directional Functional Reach test is an inexpensive and very simple way of measuring limits of stability in an older adult. This test assesses limits of stability in the forward, backward, left and right directions. The MDFR assesses limits of stability by having an individual perform a maximal reach with an outstretched arm in each direction. The individual is asked to complete each reach with feet remaining flat on the floor. It has been shown to be valid and reliable and is commonly performed in the clinic. The MDFR has been shown to have a fair correlation with both the TUG and the Berg Balance Scale.
LEARNING OBJECTIVES:
Learn how to administer the Multi-Directional Functional Reach test
Learn the normative values for the Multi-Directional Functional Reach test
Learn what components of balance the Multi-Directional Functional Reach test is measuring
Learn what equipment is required for the Multi-Directional Functional Reach test
Learn what populations this tool has been tested on
Learn the cut off scores for this test
MULTI-DIRECTIONAL FUNCTIONAL REACH TEST:
This test is used to screen dynamic balance and limits of stability in the forward, backward, left and right directions. No training is needed prior to performing this test. A yardstick is placed on a tripod or is affixed to a wall at the level of the participant’s acromion process. The person administering the test uses a level to ensure the yardstick is horizontal with the floor. The participant is then asked to raise their outstretched arm to shoulder height. An initial measurement is taken and the longest finger is used as a reference point. The individual is then instructed to reach as far as possible in the forward direction while keeping the feet flat on the floor. The individual then changes positions to perform a maximal right, left and backward reach. Prior to performing a backward reach the individual is instructed to lean as far back as possible. The individual is allowed to employ any strategy to complete the task as long as they do not take a step and the feet remain flat on the floor.
WHAT ASPECTS OF BALANCE IS THE MDFR TESTING:
The MDFR is testing the limits of stability component of balance. Limits of stability refers to the amount an individual can move their center of gravity outside of their base of support without losing their balance. Limits of stability has been shown to decline with age.
POPULATIONS TESTED:
Studies have been performed on community dwelling adults, community dwelling elderly, inner city older adults, and personal care home residents.
EQUIPMENT NEEDED:
Tripod
Yardstick
Level
NORMATIVE VALUES:
These values were found in a study by Newton. The citation can be found in the references section. The mean age in this study was 74.
Community Dwelling Elderly:
Forward Direction – 8.9 inches +/- 3.4
Backward Direction – 4.6 inches +/- 3.1
Right Direction- 6.86 inches +/- 3.0
Left Direction – 6.61 +/- 2.9
Inner City Older Adult Population:
Forward Direction – 8.9 inches +/- 3.3
Backward Direction – 4.6 inches +/- 3.0
Right Direction – 6.8 inches +/- 3.0
Left Direction – 6.6 inches +/- 2.8
Personal Care Home (PCH) Residents
Forward Direction – 5.6 inches +/- 3.0
Backward Direction – 2.9 inches +/- 2.2
Right Direction – 3.3 inches +/- 2.5
Left Direction – 3.7 inches +/- 3.1
CUT OFF VALUES:
Forward – 8.38 inches
Backward – 4.06 inches
Right – 6.12 inches
Left – 5.67 inches
SEM/MDC/MCID:
The Standard Error of Measurement, Minimal Detectable Change and Minimal Clinically Important Differences have not been established for this test.
Holbein-jenny MA, Billek-sawhney B, Beckman E, Smith T. Balance in personal care home residents: a comparison of the Berg Balance Scale, the Multi-Directional Reach Test, and the Activities-Specific Balance Confidence Scale. J Geriatr Phys Ther. 2005;28(2):48-53.
Langley FA, Mackintosh SF. Functional Balance Assessment of Older Community Dwelling Adults: A Systematic Review of the Literature. The Internet Journal of Allied Health Sciences and Practice. 2007 Oct 01;5(4), Article 13.
Newton, R. A. "Validity of the Multi-Directional Reach Test: A Practical Measure for Limits of Stability in Older Adults." The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 56.4 (2001): n. pag. Web.
"Rehab Measures - Multidirectional Reach Test; Reach in Four..." The Rehabilitation Measures Database. N.p., n.d. Web. 03 July 2016.
Tantisuwat, Anong, Dannaovarat Chamonchant, and Sujitra Boonyong. “Multi-Directional Reach Test: An Investigation of the Limits of Stability of People Aged between 20–79 Years.” Journal of Physical Therapy Science 26.6 (2014): 877–880. PMC. Web. 3 July 2016.
The Multi-Directional Functional Reach test is an inexpensive and very simple way of measuring limits of stability in an older adult. This test assesses limits of stability in the forward, backward, left and right directions. The MDFR assesses limits of stability by having an individual perform a maximal reach with an outstretched arm in each direction. The individual is asked to complete each reach with feet remaining flat on the floor. It has been shown to be valid and reliable and is commonly performed in the clinic. The MDFR has been shown to have a fair correlation with both the TUG and the Berg Balance Scale.
LEARNING OBJECTIVES:
MULTI-DIRECTIONAL FUNCTIONAL REACH TEST:
This test is used to screen dynamic balance and limits of stability in the forward, backward, left and right directions. No training is needed prior to performing this test. A yardstick is placed on a tripod or is affixed to a wall at the level of the participant’s acromion process. The person administering the test uses a level to ensure the yardstick is horizontal with the floor. The participant is then asked to raise their outstretched arm to shoulder height. An initial measurement is taken and the longest finger is used as a reference point. The individual is then instructed to reach as far as possible in the forward direction while keeping the feet flat on the floor. The individual then changes positions to perform a maximal right, left and backward reach. Prior to performing a backward reach the individual is instructed to lean as far back as possible. The individual is allowed to employ any strategy to complete the task as long as they do not take a step and the feet remain flat on the floor.
WHAT ASPECTS OF BALANCE IS THE MDFR TESTING:
The MDFR is testing the limits of stability component of balance. Limits of stability refers to the amount an individual can move their center of gravity outside of their base of support without losing their balance. Limits of stability has been shown to decline with age.
POPULATIONS TESTED:
Studies have been performed on community dwelling adults, community dwelling elderly, inner city older adults, and personal care home residents.
EQUIPMENT NEEDED:
NORMATIVE VALUES:
These values were found in a study by Newton. The citation can be found in the references section. The mean age in this study was 74.
Community Dwelling Elderly:
Inner City Older Adult Population:
Personal Care Home (PCH) Residents
CUT OFF VALUES:
SEM/MDC/MCID:
The Standard Error of Measurement, Minimal Detectable Change and Minimal Clinically Important Differences have not been established for this test.
ADDITIONAL RESOURCES:
References:
Holbein-jenny MA, Billek-sawhney B, Beckman E, Smith T. Balance in personal care home residents: a comparison of the Berg Balance Scale, the Multi-Directional Reach Test, and the Activities-Specific Balance Confidence Scale. J Geriatr Phys Ther. 2005;28(2):48-53.
Langley FA, Mackintosh SF. Functional Balance Assessment of Older Community Dwelling Adults: A Systematic Review of the Literature. The Internet Journal of Allied Health Sciences and Practice. 2007 Oct 01;5(4), Article 13.
Newton, R. A. "Validity of the Multi-Directional Reach Test: A Practical Measure for Limits of Stability in Older Adults." The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 56.4 (2001): n. pag. Web.
"Rehab Measures - Multidirectional Reach Test; Reach in Four..." The Rehabilitation Measures Database. N.p., n.d. Web. 03 July 2016.
Tantisuwat, Anong, Dannaovarat Chamonchant, and Sujitra Boonyong. “Multi-Directional Reach Test: An Investigation of the Limits of Stability of People Aged between 20–79 Years.” Journal of Physical Therapy Science 26.6 (2014): 877–880. PMC. Web. 3 July 2016.